MEDICARE: PHILADELPHIA EMPOWERMENT CLINIC PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1396323440
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHILADELPHIA EMPOWERMENT CLINIC PLLC

Provider Business Mailing Address
First Line	:	533 E GIRARD AVE # 604
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-3311
Country	:	US
Telephone Number	:	445-455-6045
Fax Number	:	267-762-4374

Provider Business Practice Location Address
First Line	:	533 E GIRARD AVE # 604
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-3311
Country	:	US
Telephone Number	:	445-455-6045
Fax Number	:	267-762-4374

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	CHARLES. TYSON
Credential	:	LCSW. BCD
Telephone Number	:	445-455-6045

Provider Enumeration Date	:	03/31/2021
Last Update Date	:	07/08/2023

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